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Resources for Addressing Spiritual Issues within Treatment for “Psychosis”

There are lots of ways to learn more about this topic!  To organize it a little, I have arranged things under 3 headings, “perhaps most interesting,” “possibly next most interesting,” and “also of possible interest.”  Of course, that may not accurately predict what is of most interest to you.  I do hope you keep exploring, and that you feel free to contact me with feedback or more ideas!

Perhaps Most Interesting:

Psychosis and Spirituality: Exploring the New Frontier edited by Isabel Clarke.  “Spirituality and psychosis both inhabit the region where ordinary reason ceases to function and barriers break down. The connection between them is evident – what is remarkable is how conventional thinking obscures the connection. This book challenges conventional understandings with a radical new perspective.  The interface between psychosis and spirituality is explored, drawing on key research and latest developments from a wide spread of disciplines…”              Various books and papers by Isabel Clarke are either referenced or available at her website,  You can also watch this video presentation about her approach to psychotic experiences.

“Mysticism and madness: Different aspects of the same human experience?” by Charles Heriot-Maitland, in Mental Health, Religion & Culture, Volume 11, Issue 3, 2008.  Abstract: Associations between mysticism and madness have been made since earliest recorded history, and the striking resemblance between self-reports of both mystical and psychotic experience suggests that similar psychological processes may be involved in their occurrence. By exploring the similarities, and proposing a common element to mystical and psychotic experience (referred to here as the experience of ‘oneness’), this paper aims to place mysticism and madness onto the same experiential continuum. However, in contrast to much of the previous literature, the intention is not to pathologize mystical experience, but rather to normalize psychotic experience. The paper argues not only that the experience of oneness is entirely genuine and available to all humans, but also that it has an important psychological (and evolutionary) function. Using cognitive terminology, it then attempts to explain the processes determining whether an individual enjoys a fulfilling mystical experience, or suffers a debilitating psychotic breakdown (i.e., how ‘oneness’ is experienced). Finally, this paper turns to look at some of the important implications such an approach might have for clinical practice and for the mental health of people in general.

“Pivotal mental states:  Spiritual highs and mental breakdowns are both products of the same evolved brain system granting us the power to transform” 

The Shaman and Schizophrenia, Revisited reviews the history of thinking about whether there is a connection between shamanism and schizophrenia, then presents evidence that “the practice of the faith, and their training in apprenticeship, may diminish the negative voices so characteristic of schizophrenia
and enable the individual to develop reasonable relationships with other voices that come to be experienced as positive.”

Trials of the Visionary Mind: Spiritual Emergency and the Renewal Process by John Weir Perry.  Perry writes from the unique perspective of having overseen a successful program for people experiencing early psychosis that used a spiritual perspective – the program called Diabasis.  “Stress may cause highly activated mythic images to erupt from the psyche’s deepest levels in the form of turbulent visionary experience. Depending on whether the interactions between the individual and the immedtiate surroundings lean toward affirmation or invalidation, comprehension of these visions can turn the visionary experience into a step in growth or into a disorder, as an acute psychosis. Based on his clinical and scholarly investigations, John Weir Perry has found and formulated a mental syndrome which, though customarily regarded as acute psychosis, is in actuality a more natural effort of the psyche to mend its imbalances. If the upset is received in the spirit of empathy and understanding, and allowed to run its course, an acute episode can be found to reveal a self-organizing process that has self-healing potential.”  Also see “A CONVERSATION WITH DR. JOHN WEIR PERRY” available at

Michael Cornwall, who worked at I Ward and studied with John Weir Perry, wrote a great summary of how to approach someone with psychosis with spiritual openness – see the comments section,  How to best serve clients with a psychotic/visionary experience

INTEGRATING THE SPIRIT WITHIN PSYCHOSIS: ALTERNATIVE CONCEPTUALIZATIONS OF PSYCHOTIC DISORDERSby Phillips, Russell E, Lukoff, David, Stone, Mary K.  “This literature review integrates theory, research, and treatment regarding spiritual experiences in persons with psychosis. The goal of this article is to further communication amongst mainstream and transpersonal psychologists regarding their approaches toward spirituality and psychosis. Perspectives presented in this paper include Anton Boisen’s pastoral counseling approach, John Weir Perry’s Jungian approach, Stanislav Grof’s and David Lukoff’s transpersonal approaches, research and treatment in mainstream psychology on religious coping and ways to incorporate religious and spiritual issues into therapy. The article also provides a framework to integrate this diverse body of knowledge, and affords some suggestions for future research.”

Religious Trauma Syndrome: How Some Organized Religion Leads to Mental Health Problems Also check out Journey Free:  Recovery from Harmful Religion  which offers a variety of resources.

What happens if we listen to psychosis? tells the story of 2 young women who believed God spoke to them and promised they would give birth to the second savior, one where the person was listened to with some humility on the part of the mental health worker, one where the person wasn’t…..

Paul Levy’s story is told at “Madness” as a spiritual and awakening journey

Myths, Shamans and Seers: Phil Borges at TEDxRainier is a video that covers cultures around the world that see “mad” experiences as an indication of possible abilities outside the norm.    Crazywise is a full length film that Phil directed, which explores this in much more detail.  You can also use that link to access a variety of blogs and interviews related to the same topic. 

Emerging Proud is a film, and a social movement, about reframing mental distress as a transformation process.

Silverstein, S. M. (2007). Integrating Jungian and Self-Psychological Perspectives Within Cognitive-Behavior Therapy for a Young Man With a Fixed Religious Delusion. Clinical Case Studies, 6(3), 263-276.   From the abstract:  “This article demonstrates how the Jungian technique of archetypal amplification was modified and used within the structure of CBT treatment of a young man with schizophrenia with a religious delusion who refused to engage in standard CBT. His case demonstrates that schizophrenia patients who initially refuse to question the validity of their delusional beliefs can nevertheless be successfully engaged in CBT when the focus promotes alternative understandings of the self and preserves self-esteem.”

Spirituality and hearing voices: considering the relation by Simon McCarthy-Jones, Amanda Waegeli & John Watkins.  Reviews how seeing voices as spiritual may provide benefits or increase problems, depending on various factors.

Multicultural Competence, Intense Spiritual Experiences, and Mental Health: A Self-help, Peer Support and Service Provider Technical Assistance Tool” Written by: Rev. Laura L. Mancuso, M.S., C.R.C.  This resource tool highlights the major findings from a STAR Center workshop regarding multicultural competence, intense spiritual experiences and mental health. It presents the recommendations developed by participants from diverse backgrounds who met over two days using a consensus workshop process.

Caroline Mazel-Carlton is a survivor of psychiatric crisis diagnosed as psychosis,  and part of the Jewish Renewal movement studying to be a rabbi.  In this interview, she addresses questions such as, “What does Jewish theology have to teach us about madness and psychiatric diagnosis?”  Or check out the recorded webinar, Ancestral Maps, Meaning, and Messages Spiritual Frameworks for Extreme States.

There are lots of free resources and other information about Compassion Focused Therapy at websites like The Compassionate Mind Foundation (which links to some articles related to psychosis specifically), The Compassionate Mind Foundation USA, and Mindful Self Compassion.  Applications of this approach to psychosis are quite new, but are explored in articles like Johnson, D. P., D. L. Penn, et al. “A pilot study of loving-kindness meditation for the negative symptoms of schizophrenia.” Schizophr Res 129(2-3): 137-40, Compassion Focused Approaches to Working With Distressing Voices, and Mayhew, S. L. and P. Gilbert (2008). “Compassionate mind training with people who hear malevolent voices: a case series report.” Clin Psychol Psychother 15(2): 113-38.  There is also a book out called “A Compassionate Approach to Recovering from Psychosis : A Self-Help Guide Using Compassion Focused Therapy Techniques” by Ian Lowens. Or check out a series of 15 free videos about how to compassionately engage with voices.

Possibly Next Most Interesting:

Spiritual aspects of psychosis and recovery” by Dr Susan Mitchell.  From the paper:  “When working with people suffering from psychosis, a practical, grounded, ‘recovery-oriented’ spirituality that incorporates humanity and compassion while accepting the integrity of personal experience is invaluable.”

Unshrinking Psychosis: Understanding and Healing the Wounded Soul by John Watkins, contains a well researched chapter on Psychosis and Spirituality.

Rufus May has written about using mindfulness with voices:  or this youtube talk on the same subject

Voices and Spirituality is explored on the Understanding Voices website.

The California Mental Health & Spirituality Initiative web site contains a directory to online resources, scientific literature, and books. It also incorporates web 2.0 features to allow you to participate by posting resources and contributing to online discussions.

Invisible Guests: The Development of Imaginal Dialogues, by Mary Watkins.  One description of this book:  “An eloquent critique of developmental and clinical psychologies and their insistence on listening to only one voice per person. Dr. Mary Watkins is the only person now writing on imagination who knows the field completely, thinks beautifully, and can teach just how to proceed with interior dialogues with imaginal personages.”

Hearing voices, demonic and divine : scientific and theological reflections.  Open Access at that link.  “Experiences of hearing the voice of God (or angels, demons, or other spiritual beings) have generally been understood either as religious experiences or else as a feature of mental illness……The present work considers biblical, historical, and scientific accounts of spiritual and mystical experiences of voice hearing in the Christian tradition in order to explore how some voices may be understood theologically as revelatory. ”

The Web of Life: A New Scientific Understanding of Living Systems by Fritjof Capra is a good introduction to complexity theory, emergence, and self organization, for those of you who may be unfamiliar with this way of thinking.

In Case of Spiritual Emergency: Moving Successfully Through Your Awakening by Catherine G. Lucas, 2011  Personal stories of spiritual crises are presented alongside practical and effective guidance in this exploration of a fascinating phenomenon. When spiritual emergencies, such as mystical psychosis and dark nights of the soul, are understood, managed, and integrated, they can offer enormous potential for growth and fulfillment, and this book offers three key phases for successful navigation. Encouraging, supportive, and life-saving, this resource is essential for avoiding the mental, emotional, or spiritual paralysis or exhaustion that can result from underestimating the current age of increased individual and global emergencies.

The Theory of Positive Disintegration by Kazimierz Dabrowski is a theory that has been around for a number of decades, for an overview of how disintegration can contribute to higher levels of integration, go to

Could Multiple Personality Disorder Explain Life, the Universe and Everything?  This Scientific American blog article proposes an interesting perspective on consciousness:  that consciousness in the entire universe is “one” but due to dissociation we have a sense of individual beings with individual consciousness.

Spirituality, Culture and World Views in Mental Health Recovery is a thoughtful talk by Sharon Smith that investigates ways to bring various dimensions of spirituality into mental health treatment, while respecting individual and cultural differences.

Spirituality, Culture and World Views in Mental Health Recovery is a recorded webinar by Dr. Sharon Smith.  She also offers a list of resources at

Shades of Awakening is a community  that provides a compassionate container to explore all things related to Spiritual Emergence(y) and Transformational Crisis.  Check out the Shades of Awakening Facebook page.

Rethinking Madness is a book by Paris Williams, which can be downloaded for free.  “In Rethinking Madness, Dr. Paris Williams takes the reader step by step on a highly engaging journey of discovery, exploring how the mainstream understanding of schizophrenia has become so profoundly misguided, while crafting a much more accurate and hopeful vision of madness. As this vision unfolds, we discover a deeper sense of appreciation for the profound wisdom and resilience that lies within all of our beings, even those we may think of as being deeply disturbed, while also coming to the unsettling realization of just how thin the boundary is between so called madness and so called sanity.”

Am I Bipolar or Waking Up? By Sean Blackwell, explores the spiritual aspects of “bipolar disorder.”  Sean writes based on his own experiences and then over 10 years of exploring the topic and helping others recover.  This book is available as a free download at this site, and there are also links to lots of videos.

A number of ISPS-US recorded webinars relate to this topic.  See for example the one on Shamanic Spiritual Emergencies, or the one with John Herold on Process Work with Altered and Extreme States, or the one with Sean Blackwell on Using Holotropic Breathwork or this Introduction to Recovery Oriented Cognitive Therapy for Psychosis.

Also of possible interest:

The Royal College of Psychiatry Spirituality and mental health webpage.  An overview of how to bring more spirituality into mental health care.  See also The Royal College of Psychiatrists Spirituality and Psychiatry Special Interest Group

The relationship between schizophrenia and religion and its implications for care.”  Mohr SHuguelet P. Swiss Med Wkly. 2004 Jun 26;134(25-26):369-76. “This paper focuses on the relationships between schizophrenia and religion, on the basis of a review of literature and the data of an ongoing study about religiousness and spiritual coping conducted among outpatients with chronic schizophrenia.”

Spiritual and Religious Competencies in Clinical Practice: Guidelines for Psychotherapists and Mental Health Professionals In this book, two clinical psychologists provide a much-needed, research-based road map to help professionals appropriately address their clients’ spiritual or religious beliefs in treatment sessions.  (This book has a lot of good and very accessible guidance, but from my point of view it can also be shallow at times, for example spending too much time imagining a clear distinction between “psychopathology” and spiritual emergencies, and then conceptualizing things like an impairment in school functioning as a sign of the former.)

Spirituality & Mental Health Understanding Extreme Spiritual States & How to Care for Them is a free booklet available at that link.

The Primordial Mind in Health and Illness: A Cross-Cultural Perspective by Michael Robbins.  “The universal quest to create cosmologies – to comprehend the relationship between mind and world – is inevitably limited by the social, cultural and historical perspective of the observer, in this instance western psychoanalysis. In this book Michael Robbins attempts to transcend such contextual limitations by putting forward a primordial form of mental activity that co-exists alongside thought and is of equal importance in human affairs.”

“Spirituality and Psychiatry” edited by Chris Cook, Andrew Powell & Andrew Sims (2009) published by RCPsych Publications (The Royal College of Psychiatrists).

“Wrestling with Our Inner Angels: Faith, Mental Illness, and the Journey to Wholeness” by Nancy Kehoe (2009) published by Jossey-Bass (A Wiley Imprint).

“Religion and Spirituality in Psychiatry” edited by Phillipe Huguelet & Harold G. Koenig (2009) published by Cambridge University Press (Cambridge, UK).

Whitson, J. A., & Galinsky, A. D. (2008). Lacking control increases illusory pattern perception. Science, 322(5898), 115-117. This article reports on research showing that as people attempt control in situations where it is not obvious how to get control, they open their mind to seeing many more possible patterns, which then makes it more likely that patterns will be seen where they don’t exist, paranoid or superstitious beliefs will be endorsed, etc.

Insanity and Divinity: Studies in Psychosis and Spirituality edited by John Gale, “Covering the interrelation of psychosis and spirituality from a number of angles, Insanity and Divinity will generate dialogue and discussion, aid critical reflection and stimulate creative approaches to clinical work for those interested in the connections between religious studies, psychoanalysis, anthropology and hagiography.”  It’s an ISPS sponsored book.

Hearing Voices in the Christian Mystical Tradition’ is a podcast by Chris Cook which explores examples illustrating some of the different ways in which voices contribute significantly to, and interpret, mystical experience.

In my seminars I often mention the San Francisco Suicide Club, a group I participated in during my youth, and my friend John Law, who once assaulted the staff person who tried to proselytize him while he was in a psychiatric hospital:  John became a leader in the Suicide Club and then in the Cacophony Society which was “spawned” by the Suicide Club, and then an early leader in Burning Man which was taken into the desert by the Cacophony Society.  John is coauthor of the book “Tales of the San Francisco Cacophony Society,” which tells that story.  (These groups were more bizarrely creative than obviously “spiritual” but were on that cusp of insanity, spirituality, and creativity…….)

God in the brain: Experiencing psychosis in the postsecular United States explores the ways people may blend spiritual and secular understandings.

Attachment and coping in psychosis in relation to spiritual figures explores a variety of attachment issues.

Navigating Cultural Dilemmas about Religion and Spirituality is a 7 minute video about the need to address spiritual issues in collaborative care.  More ideas can be found in this guide to Delivering Culturally Competent Care in First Episode Psychosis.

Religion, Spirituality, and Psychotic Disorders, by Harold G. Koenig,

Brewer-Smyth, K., & Koenig, H. G. (2014). Could Spirituality and Religion Promote Stress Resilience in Survivors of Childhood Trauma? Issues in Mental Health Nursing, 35(4), 251-256.

Dworsky, C. K. O., Pargament, K. I., Wong, S., & Exline, J. J. (2016). Suppressing spiritual struggles: The role of experiential avoidance in mental health. Journal of Contextual Behavioral Science, 5(4), 258-265.

Hardy, Sir Alistair C. The Spiritual Nature of Man: A Study of Contemporary Religious Experience. Oxford: Clarendon Press, 1979.

Perceval, J. (1961). Perceval’s narrative; a patient’s account of his psychosis, 1830-1832. Stanford, Calif.,: Stanford University Press.

Posey, T. B., & Losch, M. E. (1983). Auditory hallucinations of hearing voices in 375 normal subjects. Imagination, Cognition and Personality, 3 (2), 99–113.

Questions you might want to ask each of your clients:

  • Do you have religious or spiritual beliefs which are a source of support for you? If so, how?
  • Do you have religious or spiritual beliefs which cause you stress or conflict? If so, how?
  • Do you have any religious or spiritual beliefs that might conflict with treatment? What are they, and how do you see the conflict happening?
  • Are you a member of a religious or spiritual community that provides you with support? What sort of support are you getting from that community?
  • Can you identify specific spiritual needs related to your current problems that need to be addressed?

(These questions are a paraphrase of questions suggested in a talk by Harold G. Koenig, MD)